Adams: Can you talk a little about yourself, your career, and influence trajectory?
Miller: I trained as a registered nurse (RN) at the Royal Melbourne Hospital in Australia and completed a postgraduate certificate in intensive care unit (ICU) nursing at the Alfred Hospital, Melbourne. At that time, there really wasn't a solid career path for nurses, so I went back to university and completed a bachelor of arts in applied psychology. The early work of Colin Cameron, 1 of my professors, involved analyzing pilot error in the United Kingdom (UK). In World War II, many casualties involved trainee pilots. The more Colin spoke about the design of the cockpit instrumentation and how technology can lead to error, I saw similarities in ICU technology consoles. Errors were often unavoidable, and most of us blamed ourselves for being careless or not focused. Colin's main message was that technology shapes behavior and can have a powerful effect on safety, productivity, and satisfaction.
In the early 90s, there were few opportunities in Australia for involvement in the design of healthcare technology. Instead, I worked as a consultant in telecommunications designing computer screens for call center operators. By the late 90s, I worked for Coopers and Lybrand, implementing large-scale Enterprise systems, where I became interested in how technology influenced decision making. Coopers was supportive of staff seeking higher education. At a conference in Sydney, I spoke to Prof Penelope Sanderson, who had just returned to Australia from the US. She had a long history of human factors research in power generation and process control, and in 2000, following release of the IOM's report To Err is Human,1 she became interested in healthcare human factors. With my nursing background, it was a great opportunity.
Penny encouraged students to attend international conferences, especially in the US. I attended several Human Factors and Ergonomics Society annual meetings and met Dr Matthew Weinger, known for his research in patient safety and the design of medical devices. By the time I had finished my PhD, Matt had moved to Vanderbilt University Medical Center and met Dr Peter Buerhaus, a leader in nursing workforce-related research. Peter recognized the relevance of human factors to nursing. Matt and Peter invited me to complete postdoctoral studies at the School of Nursing at Vanderbilt. My husband and I planned on being here for 2 years and we are now in our 8th. I look forward to continuing to work in the design and implementation of systems that support nursing work.
Adams: Among other things, you are a human factors expert[horizontal ellipsis]why and how is this field of importance to nurse administrator readers of JONA?
Miller: Human factors is the science and practice of designing artificial environments in ways that complement and support human work and well-being. The integration of technology, especially information technology, presents some of the most significant challenges to nursing. As humans, we have extraordinary capabilities. With experience, we are able to recognize critical changes in patients, to anticipate future needs, plan adaptively, and make critical judgments in response to changing circumstances. We can pool team resources and coordinate efforts to achieve common goals and outcomes. I was astonished by nurses' ability to reconfigure their efforts to meet the demands of changing conditions, both at the patient and the team levels. But we are also prone to disruptions and distractions; we become fatigued and inattentive when given repetitive tasks or tasks that don't fully utilize our abilities. New technology changes the way we think and make sense of our work; it changes the way we communicate and the way we work. Technology in this sense is not benign; it can have intended and unintended effects. Human factors expertise can aid in better understanding how new technology affects nursing work and how it may be better designed and integrated so as to enhance rather than detract from it.
Adams: Dr Miller, can you share about some of your work you feel has made or can make the biggest impact?
Miller: In collaboration with Kathleen Burns, RN, clinical educator, and Dr Chad Wagner, medical director of the cardiovascular ICU at Vanderbilt, we developed a tool to support the continuity of care of post-cardiothoracic surgery patients. The tool laid out the plan of a patient's care across the 1st 48 hours postsurgery. The plan was divided into milestones that can be met routinely within timeframes. For example, a routine postoperative patient would be expected to be awake and extubated approximately 6 hours postsurgery. If the patient was not extubated at this time, then either the team was not working effectively or there was something unexpected happening. Either case should require a reassessment of the situation. Using the tool, nurses were empowered to escalate patient assessments if patients weren't achieving milestones. If patients were meeting milestones, they were empowered to work towards the next milestone. The thing that I was most proud of in this project was the development of a technology that enhanced interdisciplinary teamwork, empowering nurses to act. We achieved significant reductions in ICU length of stay and were able to identify earlier those patients who were not responding as expected. We published this work in the Journal of Cardiothoracic and Vascular Anesthesia.2
Adams: How can we prepare the next generation of nurses to lead and advance the profession?
Miller: Diversity will be an increasingly important characteristic of most professional roles, including nursing. Diversity of experience, skills, and abilities is the basis for creative and adaptive problem solving. I think diversity starts early, if not during high school, then certainly in undergraduate studies. It includes a range of work experiences including nonhealthcare experience, interest in creative arts as well as science, and diverse sports and physical activity. Selecting, employing, and remunerating nurses who are multidimensional in their outlook and orientation and who are able to draw on these experiences to their work as nurses, leaders, and administrators will provide a critical resource pool when dealing creatively with uncertainty. These people are sometimes easier to work with and are essential in bringing new perspectives.
Adams: What final thought would you like the JONA readers to know?
Miller: Human factors professionals and researchers can provide a valuable perspective on nursing work and are highly willing to share tools, techniques, and approaches. The Human Factors and Ergonomics Society (HFES) has a special track for nurses. I would encourage nurses to consider becoming involved in HFES. The healthcare technical group is 1 of the most active (http://hctg.wordpress.com/).
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